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Пульмонология, гематология (англ,рус)

Treatment iron is conducted 4-6 months: in a complete dose preparations appoint to normalization of indexes of red blood, whereupon a dose is diminished half.

 

Basic modern drugs

A. Monocomponent preparations

-         Arystiferon (ferrum sulfas)

-         Ferro-gradument (ferrum sulfas)

-         Ferronal (ferrum gluconas)

-         Ferrogluconat (ferrum gluconas)

-         Hemofer prolongatum (ferrum sulfas)

-         Heferol (ferrum fumaras)

-         Iron vine (ferrum sacharas)

B. Combine preparations

-         Tardyferon-retard (ferrum sulfas, Vit C)

-         Gyno-tardyferon (ferrum sulfas, Vit C, folic acid)

-         Sorbifer-durulis (ferrum sulfas, Vit C)

-         Fenuls (ferrum sulfas, Vit C, B)

-         Makrofer (ferrum gluconas, folic acid)

-         Aktyferrin (ferrum sulfas, D,L-seryn)

-         Globiron (ferrum fumaras)

-         Ranferon (ferrum fumaras, Vit C, B12, B9, Zinci sulfas)

C. Preparations for parenteral introduction

•         Ferbitol

•         Fercoven

•         Ferrum-lek

•         Venofer

•         Maltofer

•         Ferlecyt

•         Gektofer

 

CRITERIA OF IRON DEFICIENCY ANAEMIA TREATMENT EFFICIENCY

7-10 days – retikulocytes` crisis,

3-4 weeks - normalization of hemoglobin level, amount of blood red corpuscles and hematokrit,

10-12 week - normalization of blood ferritin level.

 

STANDARDS OF DIAGNOSTICS AND TREATMENT OF MEGALOBLASTIC ANEMIA

Megaloblastic anemia is anemia, caused disturbances of DNA and RNA synthesis in erythroid cells which appear on the basis of vitamin of В12 and folic acid deficit.

Reasons of megaloblastic anemia:

•         Addison-Birmer disease   (autoimmune   disease, caused by the presence of antibodies against the Kastl`s internal factor of);

•         State after the resection of stomach;

•         Stomach cancer;

•         Diseases of thin intestine;

•         Parasitizes diseases;

•         Initial deficit of transcobalamin II;

•         Alimentary insufficiency of vitamin В12.

 

This image shows a large PMN with multiple discretely-identifiable nuclear lobes, usually seen in megaloblastic anemias. Normal PMN's have less than or equal to 5 lobes.

This picture shows large, dense, oversized, red blood cells (RBCs) that are seen in megaloblastic anemia. Megaloblastic anemia can occur when there is a deficiency of vitamin B-12.

Diagnostic search

lConducted additionally:

l- sternal punction - megaloblastic type of erythropoesis;

l- fibrogastroskopia, biopsy of mucus stomach;

l- establishment of reason of vitamin В12 or folic acid deficit.

Anamnesis: to pay attention to gradual development of disease, general weakness.

Clinics - characteristic triad of syndromes:

1. Anemic (pallor of skin and mycoses, subikterosis of skin and sclera);

2. Damage of digestive organs (Genter`s tongue - in the first phase bright red, sickly, later - smooth, glossy; atrophic gastritis);

3. Neurological syndrome (funikularis myelosis).

 

Characteristic changes:

hyperchromic anemia (colored index > 1.0), leukopenia, can be thrombocytopenia, in blood analysis - makrocytosis, elliptocytosis, anisocytosis, bazofil grittiness appears in red corpuscles, red corpuscles with the Kebot`s rings and little Zholli`s bodie, gigantic neutrophiles with the hypersegmented kernel;analysis of gastric juice (histaminrezisten inacidity); increasing of indirect bilirubin.

 

Reasons of folic acid deficit:

l- alcoholism;

l- liver cirrhosis;

l- violation of absorption of folic acid is in a thin bowel;

l-alimentary insufficiency of folic acid;

l-taking   some   medicines   (antagonists   of purins, sulfanilamides).

 

Treatment of the vitamin В12 deficit:

•          vitamin В12  (cyanocobalamin) in a dose 500 mkg intramuscular daily during 2 weeks, and later - one time for a week to normalization of indexes of red blood;

•         dispansery supervision of  hematologist - the vitamin В12 in a dose 500 mkg intramuscular one time on a month during all life;

•         patients with the expressed neurological syndrome during the first half-year get the dose of vitamin В12 on 50 % more high;

•         used the transfusion of red corpuscles concentrate only in extremely heavy cases at presence of cardio-vascular insufficiency.

 

 

Treatment of the folic acid deficit:

 

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